My brother called me a few days before Thanksgiving and said that he had some odd news from his doctor’s visit. He had been having some back pain which had moved around to his abdomen. He thought it might be a kidney stone, which he had had before. He had a regular checkup scheduled, so when he told his doctor about it, the doctor ordered an ultrasound.
As you probably know, technicians who perform tests like ultrasounds are seldom willing to tell you anything, but in this case, she mentioned that there were a lot of spots on his liver, something my brother had, I think, also noticed. My brother left without a definitive diagnosis. Doctors’ notes are often available online these days, so my brother checked on his. The notes referred to metastatic cancer of the liver of unknown origin. The likely sources of cancer that has metastasized to the liver are the prostate, the colon, and the pancreas. My brother’s prostate numbers were good, and his three-year-old colonoscopy was clear. That left one dreadful possibility — the cancer had spread from the pancreas.
Still, the results of an ultrasound aren’t definitive. My brother found some more benign possibilities to explain the spots on the liver, which he told me about. We essentially agreed to withhold our own judgement until any other possibilities were eliminated, but I think both of us knew there was only a slim hope.
My brother told me and his wife about the finding, but he did not tell his two sons. The holidays were almost on us, and his younger son was getting married on December 1 in Washington, DC. My brother was to perform the wedding ceremony. He did’t want to ruin Thanksgiving or the wedding, so he decided to wait till afterwards.
Leah and I went up to Chattanooga for Thanksgiving with my brother, his wife and her family, and my brother’s older son. My brother and I went out to his newly completed garage/workshop, ostensibly to let him show me around, which he did. He showed me the dust filtration system he had installed with amused irony.
My brother is an ordained Presbyterian minister, but he was a scientist long before he became a minister, and once a scientist, always a scientist. I, too, am a scientist. Not the scientist my brother is, but my outlook is shaped by it, and wishful thinking is not one of the traits generally associated with scientists.
So, how do two brothers who are also scientists discuss a diagnosis of metastatic pancreatic cancer? Once we both have done all the online reading and seen the prognosis? Matter of fact, with an underlying note of frustrated disbelief. It’s like getting the results of an experiment that are not what you expected or hoped for — you might not like it, but that feeling has nothing to do with anything.
The wedding went off well, although Leah and I couldn’t attend. In the meantime, two CT scans showed the extent of the cancer. All but one lobe of his liver had tumors, and his lungs showed a few small spots. There was a small spot in the pancreas, which a biopsy showed to be the source of the metastasized tumors.
As it happens, pancreatic cancer is a bastard. The only actual cure is to catch the cancer before it spreads and, if it’s accessible to surgery, remove it. Unfortunately, pancreatic cancer often spreads with few or no symptoms, so it is generally — almost always — detected only after it has spread. There are no routine screening techniques to detect pancreatic cancer, and the pancreas itself is buried in the abdomen so deeply that it’s difficult, if not impossible, to do something like palpate it. Pancreatic cancer tumors also have an outer layer that makes it hard to get chemo into the tumors. So, pancreatic cancer does its best to cover all the bases.
The Memorial Sloan Kettering Cancer Center website says this: “Despite decades of research, the prospects remain bleak for those diagnosed, with a survival rate of 20% at one year and 6% at five years for all stages combined. Even patients diagnosed and treated at the earliest stage have a 50% chance that the disease will recur.”
I feel like I’m betraying my brother to conclude that his outlook is bleak, indeed, but those are the facts, and, as Joe Friday said, “All we want are the facts, ma’am.”
He’s undergoing chemotherapy, despite the fact that everyone involved expects limited results. His first session knocked him on his back, literally. The first dose of chemo was very strong. The dose was reduced for the next sessions. Now, with a few sessions under his skin, he’s lost enough hair that he shaved the rest off.
Most people know about hair loss from chemotherapy. Many know about things like nausea. I knew about those things. Leah suffered some of the nausea from her chemotherapy way back when she had her colon cancer. But all through those days and right up until recently I never actually knew why it happens. Here’s why:
Chemotherapy targets rapidly dividing cells, which cancer cells certainly are. Unfortunately, there are a number of normal cells in the human body that divide rapidly, including those in hair follicles, those in the linings of the mouth, throat and digestive tract, and those in the bone marrow responsible for making blood cells. That means chemo attacks those cells as well as the cancer cells, resulting in all the side effects we expect from chemo.
The fact is that routine cancer treatment, even today, remains primitive and crude. We try to kill the cancer cells with radiation and chemicals which also damage normal cells, and we hope the treatment is not worse than the disease. I think it’s at least kind of fair to say that the only sure cure for any cancer is to cut it out before it spreads. There are some experimental approaches that seem hopeful and far less crude. Sometimes they are very effective and sometimes they are not; the researchers can’t predict who will respond and who won’t.
My brother remains stoic, or fatalistic, or, maybe just realistic about the matter. He’s hoping for a long enough period of reasonably comfortable survival to finish a piece of furniture he wants to build for his son and his new daughter-in-law. He’s looking at clinical trials, some of which offer the possibility for a somewhat longer survival if the right conditions are met. His church friends are praying for him; maybe he is, too. But he’s neither asking for nor expecting a miracle, and neither am I.